AB1148 POST COVID-19 RHEUMATIC AND MUSCULOSKELETAL DISEASES
Authors: N. Varghese, N. Loghin-Oprea, V. Sadovici-Bobeica
Journal: Annals of the Rheumatic Diseases (2022)

Background Recent data suggests that SARS-Cov-2 can alter self-tolerance and trigger autoimmune responses through cross-reactivity with host cells; therefore it can lead to late autoimmune and inflammatory manifestations. With regard to rheumatic and musculoskeletal diseases (RMDs), medical literature displays sporadic case reports describing a variety of conditions diagnosed after COVID-19, but it remains still unclear what are the most common problems in patients presenting to rheumatology clinic following COVID-19 disease. Objectives To describe the pattern of post-COVID-19 RMDs in a consecutive group of patients from rheumatology outpatient clinic. Methods We have performed an observational descriptive study of a group of adult patients who received a new diagnosis of RMD within a timeframe of 12 weeks after the confirmation of COVID-19. Data was collected based on clinical presentation, paraclinical pattern and radiological examinations. Results The study included 23 patients who were consulted in rheumatology outpatient clinic and had post COVID-19 new onset joint, periarticular, bone or inflammatory syndrome manifestations. The general characteristics of the study group were as follows: mean age 45.5±11.3 (range 21-63) years and female to male ratio of 1.8:1. The majority of subjects consulted for joint symptoms (91.4%), in other cases reason for consultation was persistent low grade fever and fatigue (4.3%) and skin rash with dyspnea (4.3%). The mean duration of symptoms was 9.8±10.5 (range 1-42) weeks, and the time of onset after COVID-19 diagnosis was 4.9±4.1 (range 0-12) weeks. Concerning COVID-19 severity, it was established that in 60.9% it was mild, 17.4 % - moderate and 21.7% - severe. After clinical and paraclinical examination, the following diseases were diagnosed: ReA, lupus like syndromes, avascular necrosis, new onset RA and new onset PsA. In 69.7% of patients were diagnosed with ReA, the clinical pattern being joint or periarticular involvement of the hand, knee and feet. In 13.0% cases patients had multisystemic involvement (myocarditis, pericarditis, skin rash, inflammatory arthritis and/or low grade fever) and positive ANA and or dsDNA Ab, these cases were diagnosed as lupus like syndromes and followed a severe form of COVID-19. In 8.7% of patients who presented with non-inflammatory hip pain, avascular necrosis was diagnosed, in both cases femoral head being the affected part. No be noted that patients with avascular necrosis had a severe form of COVID-19 disease and joint pain started later after COVID-19 diagnosis (10-12 weeks). In 4.3% of cases each, new onset RA and PsA were identified. Conclusion In the present study we have found that COVID-19 can be followed by a variety of RMDs. The most common symptom of patients presenting with RMD was joint pain. The most common disease was post-COVID ReA (69.7%). Avascular necrosis (8.7%) and lupus like syndromes (13.0%) were found in patients who experienced a severe form of COVID-19. More rarely, patients had new onset of rheumatoid arthritis (4.3%) or psoriatic arthritis (4.3%). Our findings suggest that during the COVID-19 recovery period patients might experience onset of RDMs; therefore, in the presence of joint symptoms or other manifestations suggesting an autoimmune disease, patients should be referred to a rheumatologist for careful clinical examination. References [1]Kocyigit, B. F., &amp; Akyol, A. (2021). Reactive arthritis after COVID-19: a case-based review. Rheumatology international , 41 (11), 2031–2039. [2]Liu, Y., Sawalha, A. H., &amp; Lu, Q. (2021). COVID-19 and autoimmune diseases. Current opinion in rheumatology , 33 (2), 155–162. Disclosure of Interests None declared